The Glenn Shunt

One of the more familiar operations used by Congenital Cardiac surgeons is the Glenn Shunt (Also known as the Glenn Procedure, the word “Shunt” means “detour”.) Despite being revised from its original form and falling out of favor for a time, the Glenn is often used in the repair of defective hearts.

Developed by Dr. William Glenn in the 1950’s, the original operation may not be recognized by today’s doctors. In what is now known as the Classic Glenn or the Unidirectional Glenn, the Superior Vena Cava (SVC) would be sewn closed near its junction with the Right Atrium. The Right Pulmonary Artery (RPA) is then cut and sewn into the SVC, and the open end of the Pulmonary Artery would be sewn closed. In this configuration, the Glenn Shunt only sends blood to the right lung. Here’s a good diagram of the Classic Glenn Shunt and here’s what I think is an even better drawing. The second link contains links to important information about both versions of the Glenn, worth your time to read. For the record, my first heart operation in 1967 was the Classic Glenn Shunt.

The Glenn fell out of favor after the Fontan Procedure was introduced. After years of neglect (I was told in 1977 by a surgical assistant that “we rarely do the Glenn any more”) it was looked at again when the early versions of the Fontan tended to not deliver the expected results. By then the operation had evolved into the Bidirectional Glenn Shunt. In the Bidirectional Glenn, the Superior Vena Cava is cut, and then re-sewn into the Right Pulmonary Artery. This is makes it bidirectional, as blood now flows to both lungs. Here’s a good photo of the Bidirectional Glenn (.pdf file) and here is a .pdf report on modeling a Bidirectional Glenn to study it’s affects on the individual patient. This report may appeal more to readers with a mathematical background, as the first part of the article is a complex discussion of the formulas needed to create the model.

Currently, the Bidirectional Glenn Shunt can be used as an option to repair most of the right-sided heart defects. It is also the second operation of the Norwood Procedure to repair Hypoplastic Left Heart Syndrome. (HLHS) It was first used in the Norwood in 1989; until then, the Norwood repair was a two surgery procedure.

And finally, here is a visual reminder to learn the anatomy of the heart yourself and not trust everything you find on the Internet: The text on this page correctly describes the Bidirectional Glenn Shunt, but the illustration is of a Blalock-Taussig Shunt!

8/2/2009 Update: I listed the same link twice when referring to two drawings of the Glenn Shunt! That has been corrected!

8 Responses to “The Glenn Shunt”

Dazzle me with your knowledge of the Waterston Shunt also named for the Dr. who created it, and the shunt performed on me as an infant. It is no longer taught in Medical schools meaning young interns have never heard of it. My surgical team in ’07 was all over me learning things they would never learn in the classroom further cementing my role as a human guinea pig. :-)

It is my understanding that after Dr. Blalock perfected his shunt every cardiac surgeon interested began to develop their own trying to perfect or better the original. There are as many variations out there as cutting edge Cardiologists of the time back in the early days. Great info – love your blog, Steve!

I had the waterson shunt at birth. and the the classic glenn as a early teen. The Waterston shunt in called the flawed shunt amoung most doctors. Most of the patient who had the Waterston didnt live past teenage years due to the fact the surgery cause the pulmonary vascular obstructive disease. I developed pulmonary hypertension in my right lung as a result of the Waterston, hence why I had to have the classic Glenn done on the left lung.

I had the Modified Glenn Shunt at age 2. The Fontan was originally scheduled for that day, but the size of my vessels were too small for the Fontan to be successful that day. Since my Fontan in 1986, two years after my shunt, no other open heart surgeries have had to be performed, but as you know, follow up is of the utmost importance.

Thank you for your website and the information you post. I have learned more about our shared medical condition by reading your posts and links!

You are absolutely right about the Waterston which is why they do not even teach it anymore; making me so grateful for my surgeon repairing it in my last OHS 2 years ago. I never sermonize anyone, but if there is a doubt about my belief in God there should not be. With this poorly constructed shunt performed at 1 yr (1971); I still managed a great life full of band, softball, and lot’s of boy chasing. ;-) Even when the CHF began, I was blessed with the privilege of traveling to China for adoption of my (now) 13 yr old daughter; then 4 years later her sister from India. Unfortunately we lost her to multiple diseases, but she is with God; and, I was able to identify a black-market, partial-birth abortion ring clinic selling the “premies.” It”s thanks to God I am still here today, and I hope to be of help to anyone else suffering CHD; parents, patients, or other family members.

Thanks, Steve! You do a great service with this fantastic blog, dear. :-)

As a cardiothoracic surgeon in a government hospital in Calcutta, we face a lot of poor patients with CHD and most of whom are unable to procure funds for the definitive repair through open heart surgery as most of them are not insured. So we have to do some palliativer procedures in some of them with the Tetralogy physiology. Most of our patients are older children in 7 to 16 year age rangethus getting the patients with favourable anatomical defects while most with the severe defects are eliminated naturally earlier in the lives as per Darwins law. We did four classical Glenn shunt in four cases of tricuspid atresia in the beating heart without cardiopulmonary bypass and all left went home with the advice to avoid dehydration, regular aspirin intake and multivitamins. None opted for conversion to Fontans operation due to pecuniary condition and we do not know how long they will remain well. One 16 now 19 year old male patient had frequent epistaxis but otherwise healthy with good exercise tolerance. Its heartening to learn from your comments that patients with Glenn shunt have been doing well over 20 year period.

This is so nice to hear what others have experienced as a result of their individual heart defects. My son also had the Glenn shunt followed by the Fontan procedure in 1993. Prior to that, he was constantly sick. By the time he was two months, he had pneumonia several times, CHF and meningitis. After the surgeries we had some rough patches and months of healing in the hospital. He left the hospital at 10 months weighing 9 pounds. By his first birthday, my son looked like any other child his age, weighing 20 pounds! He looked like a completely different child.
My son is now 18 and has not taken medicine for years! He graduated from high school and will soon start college. He has many friends, had girlfriends, enjoys being the oldest of a large family, loves roller coasters, rock music, drawing and looks forward to the future.
I have always felt very blessed to have one more day with my son and have always known that I was witnessing a miracle time and time again throughout his struggles to survive. After reading Dr. Dasbaksi’s post though, I feel a renewed thankfulness. My son most definitely would have been one of those who was “eliminated naturally” had we lived anywhere but the U.S. We have been so unbelievably blessed through the years and I will be forever grateful.
As a young, first-time mother in the 1990’s, I had very little knowledge about congenital heart defects. The internet was not an option so all I had to rely on were the wonderfully patient cardiology team and their plethura of information (which was way above my understanding). There were no known support groups or adult survivors. Thank goodness I had Divine intervention. Without it, I would have been a lost wreck.
I strongly urge that anybody who has experience with the effects of congestive heart defects, whether you are from the medical field, an adult survivor, a parent, grandparent, sibling, etc., please share what you have experienced. I know it would have helped me considerably. Hopefully, it will help ease the worry or the questions or maybe even prepare someone for the next step.
As a parent, my advice would be not to let the defect define your child. When your child is hospitalized, ensure that your child gets to be a kid as much as possible. Sometimes, the well-meaning medical staff is too analytical and approaches your child as a case, not a person. Remember that you are the voice for your child. Do not be intimidated by the medical professionals–ever. Remember to stimulate your child’s spirit no matter how grim things may look—their spirit is their final saving grace. Be strong, fight, learn, hope.
After all, what any good parent hopes for is that their child has a good life. As parents of a child with heart defects, we learn to be much more grateful and appreciative of each day. Rather than fearing the last day, we look forward to the next day. Good luck everyone…here’s to a great day tomorrow!